Nutrition Assessment And Clinical Application Of Nutritional Risk Screening Tools In Critically Ill Children

Nutritional risk refers to the risk of diseases caused by existing or potential nutritional and metabolic conditions or related adverse clinical outcomes after surgery.Nutritional risk screening can detect malnutrition in children in hospital early.At present,there are many kinds of nutritional risk screening tools in the world,but the advantages and disadvantages coexist,lack of widely used standards,and there are no tools suitable for Chinese children nutritional risk screening.In recent years,domestic scholars began to use STRONGchildren,PYMS and STAMP screening tools to assess nutritional risk of critically ill children,but the clinical value needs to be verified.Study found that hospitalized critically ill children had a higher incidence of malnutrition and nutritional risk,and malnutrition counts against to the treatment of critically ill children.Malnutrition made it difficult to the treatment of critical children in pediatric intensive care unit and reasonable nutritional support plays an important role in the recovery of the disease.This study through the investigation of nutritional status and nutritional risk screening of critically ill children,to explored the relationship between nutritional status,nutritional risk and clinical prognosis,in order to select suitable screening tools for nutritional risk assessment,and to provide reference for nutritional management of critically ill children.ObjectiveInvestigating the nutritional status of critically ill children,to explore the value of nutritional risk screening tools and provide guidance for clinical nutrition management.Methods211 critically ill children hospitalized in PICU from November 2017 to April 2018 were collected,including 140 boys and 71 girls,aged from 1 month to 9 years,with a median age of 3.1(2,10)months.The disease components of 211 critically ill children included respiratory diseases,cardiovascular diseases,digestive and central nervous system diseases and other diseases.All the children were completed physical measurement within 24 hours at admission(measurements were fasting,after defecation and urine),including body weight at discharge,admission(accurate to 0.01 kg),length/height(accurate to 0.1 cm),and completed pediatric critical illness score.The nutritional status of critically ill children was judged by weight of age Z value(WAZ)as gold standard and nutritional risk screening tools of STRONGkids and PYMS were used to screen nutritional risk of all critically ill children.The effectiveness of STRONGkids and PYMS in evaluating nutritional risk of critically ill children was assessed by receiver operating characteristic curve(ROC).Results1.The detection rate of malnutrition on admission was 32.2%(68 cases),including 16.1%(34 cases)of severe malnutrition,16.1%(34 cases)of moderate malnutrition,and 16.6%(35 cases)of malnutrition at discharge,including 2.4%(5 cases)of severe malnutrition and 14.2%(30 cases)of moderate malnutrition.Malnutrition occurs mainly in infancy.2.The results showed that 211 cases,73.0%(154 cases)?78.2%(165 cases)were nutrition risk,41.7%(88 cases)and 59.7%(126 cases)with moderate nutrition risk,31.3%(66 cases)and 18.5%(39 cases)with high nutritional risk through STRONGkids and PYMS.78.2%(165 cases)were nutrition risk,18.5%(39 cases)with high nutritional risk,59.7%(126 cases)with moderate nutrition risk by PYMS.Both results showed that the younger the age,the higher the nutritional risk.3.Using weight of age Z-value as the gold standard to evaluate and compare the two nutritional risk screening tools,the area under the ROC curve of STRONGkids was 0.822 and PYMS was 0.759.There was significant difference between the two methods(P<0.05),and their clinical efficacy is similar,but there was no statistical difference in clinical efficacy(P>0.05).When the best score of STRONGkid and PYMS was 3,the sensitivity was 92.1%,76.2% respectively.4.There were significant differences in the clinical prognosis of children with different nutritional risk groups at admission(P<0.05),and the clinical prognosis with moderate and high risk nutrition at admission was worse than that of children with low nutritional risk(P=0.014 and 0.001 respectivly).5.There were significant differences in clinical outcomes among children with different nutritional status at admission(P<0.05).The prognosis of severe malnutrition group was worse than that of normal nutrition group(P < 0.0167).There was no significant difference between moderate malnutrition group and severe malnutrition group and normal nutrition group(P>0.0167).ionclusions1.The incidence rate of malnutrition in critically ill children is high,which is significantly related to poor prognosis.2.The STRONGkids and PYMS for critically ill children with nutritional risk screening have similar clinical efficacy,and there was no statistical difference.Both of them have clinical application value,but STRONGkids more sensitive.